MEDICARE: MR. DIOSDADO PIOQUINTO DIZON JR. APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	835177	NV

General Provider Information

NPI Number	:	1114786613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DIOSDADO PIOQUINTO DIZON JR. APRN

Provider Business Mailing Address
First Line	:	3430 E FLAMINGO RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5018
Country	:	US
Telephone Number	:	702-444-4690
Fax Number	:	702-444-0977

Provider Business Practice Location Address
First Line	:	3430 E FLAMINGO RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5018
Country	:	US
Telephone Number	:	702-444-4690
Fax Number	:	702-444-0977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	08/14/2025

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